Health care financing system and method

ABSTRACT

A computer implemented method for determining eligibility of a patient to receive financial assistance. The method utilizes health care financial assistance information associated with at least a first potential health care financial assistance plan and a second potential health care financial assistance plan, wherein the patient is not enrolled in either of the first or second potential health care financial assistance plans at the time of the determination of the eligibility, wherein the first potential health care financial assistance plan is provided by a first health care financial assistance plan provider, wherein the second potential health care financial assistance plan is provided by a second health care financial assistance plan provider, wherein the health care financial assistance information associated with the first potential health care financial assistance plan includes first provider qualification criteria and wherein the health care financial assistance information associated with the second potential health care financial assistance plan includes second provider qualification criteria. A system for financing health care is also disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patent Ser. No.09/951,962, filed on Sep. 13, 2001, entitled “Health Care FinancingSystem and Method”, which is incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to the field of health care billingsystems, and more particularly to financing health care treatment.

2. Background of the Invention

Current methods employed by health care organizations in thequalification of applicants for health care financial assistancegenerally include the manual interpretation of demographic, health careand financial data. The interpretation of such data can include thecomparison of the data with written guidelines provided by public andprivate agencies offering health care financial assistance throughgrants, tax fund programs, and government programs such as Medicaid andMedicare. Additionally, many health care financial assistance programsrequire the interpretation of financial data, such as those obtainablethrough conventional credit reporting, as part of the grant process.Still, the interpretive result can be characterized as having less thandesirable accuracy.

Public and private financial assistance programs, of which there can bedozens at any time, have proven helpful in defraying some expensesexperienced by health care providers in providing health care servicesto individuals of less than adequate means. The suitability ofindividual assistance programs, however, can vary depending upon thedemographic, health care and financial data of each patient. Yet,identifying suitable financial assistance programs can be difficult inview both of the changing number and type of financial assistanceprograms, and the inaccuracies associated with interpreting thedemographic, health care and financial data. In many cases, thesuccessful identification of suitable assistance programs can depend onthe experience, training and knowledge of individual admitting andbilling clerks employed by the health care provider.

SUMMARY OF THE INVENTION

A method for financing health care includes the steps of: receivingpatient data in a data processing system; collecting from disparatehealth care grant systems health care grant information into a singledatabase; identifying qualification criteria in the health care grantinformation; and, comparing the patient data to the qualificationcriteria and, if the patient data satisfies the criteria, creating anotification that the criteria have been met. The patient data caninclude at least one of credit data, insurance data, and income data.The health care grant information can include qualification criteria.The health care grant system can be any suitable system, for example,Medicaid.

The single database can be accessed by the data processing systemthrough an internet connection. The health care grant information can becollected from the health care grant systems by accessing the systemsand querying for such information, and such queries and responsive datacan also be transmitted through an internet connection. The health caregrant information can also be collected from the health care grantsystems by receiving information transmitted by the health care grantsystems, as in periodic or intermittent updates.

The health care grant information can include health care grant amounts,and the method can further comprise the step of obtaining such healthcare grant amounts for health care grant systems which have criteriawhich have been satisfied by the patient data. The grant amount can becompared to the health care costs of the patient. Financing can beobtained for any portion of the health care costs of the patient inexcess of the grant amount. A health care grant application can beprovided for the health care grant system for which the criteria havebeen satisfied.

A system for obtaining health care financing includes a data processingsystem adapted to receive patient data and a single database havingstored therein the health care grant information of a plurality ofdisparate health care grant systems. The data processing system isadapted to identify qualification criteria in the health care grantinformation, to compare the patient data to the qualification criteriaand, if the patient data satisfies the criteria, to create anotification that the criteria have been met.

The data processing system can comprise structure for collecting thehealth care grant information from the health care grant systems byaccessing the systems and querying for the information. The dataprocessing system can comprise structure for collecting the health caregrant information from the health care grant systems by receivinginformation transmitted by the health care grant systems, as in regularor intermittent updates.

The health care grant information can include health care grant amounts,and the system of the invention can obtain the grant amounts for thehealth care grant systems which have criteria which have been satisfiedby the patient data. The system further can comprise structure forcomparing the grant amounts to health care costs for the patient, andfor obtaining financing for any portion of the health care costs of thepatient in excess of the amount of the grant. The system can provide ahealth care grant application for the health care grant system for whichthe criteria have been satisfied.

A machine readable storage according to the invention has stored thereona computer program for financing health care. The computer program has aplurality of code sections executable by a machine for causing themachine to perform the steps of: receiving patient data in a dataprocessing system; collecting from disparate health care grant systemshealth care grant information into a single database; identifyingqualification criteria in the health care grant information; comparingthe patient data to the qualification criteria and, if the patient datasatisfies the criteria, creating a notification that the criteria havebeen met.

BRIEF DESCRIPTION OF THE DRAWINGS

There are shown in the drawings embodiments which are presentlypreferred, it being understood, however, that the invention is notlimited to the precise arrangements and instrumentalities shown,wherein:

FIG. 1 is a schematic diagram of a health care financing systemaccording to the invention; and,

FIG. 2 is a flow diagram of a health care financing method according tothe invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The present invention is a health care financing system in which healthcare grant information can be analyzed to determine whether a patientqualifies for a health care grant. A health care financing systemaccording to the invention is shown in FIG. 1. In the health carefinancing system of the present invention, a data processing system 14is adapted to receive patient data. The data processing system 14 willtypically be operated by a health care provider 20, although it ispossible that the data processing system 14 could be operated by thepatient 24 or by another person or entity. In one aspect of theinvention, the data processing system 14 includes a database 28.

Health care grant systems maintain health care grant information inrespective health care grant system databases 32, 36 and 40. Althoughthe illustrated embodiment includes three health care grant systems, itwill be apparent that any number of health care grant systems and healthcare grant system databases are possible. The health care grant systemscan be selected from any suitable system which tracks programs whichoffer financial assistance to patients meeting qualification criteria.Such programs can include public programs such as Medicare and Medicaid,WAGES, TANF, and WIC programs, as well as private programs such asfoundations and for-profit and not-for-profit entities offering healthcare financial assistance for qualifying applicants.

Health care grant information retrieved from the health care systems 32,36 and 40 can be stored in a single database. The database can beassociated with the health care provider 20, as shown by the database28. It is also possible, however, that the database is located remotelyfrom the health care provider 20 as indicated by the database 44. Theremote database 44 can have an associated data processing system 54.Access to the remote database 44 can be accomplished by any suitablemethodology. In one aspect, access to the remote database 44 isaccomplished through the Internet 50.

The data processing system 54 can query health care grant systems 32, 36and 40 for health care grant information. The responses including thehealth care grant information can be stored in the remote database 44 orin the database 28 of the health care provider 20. In another aspect,the health care grant systems update the databases with current healthcare grant information. These updates can be periodic, and can beperformed so as to regularly update the database 28 or 44 with healthcare grant information. The updates can also be intermittent, such aswhenever there is information to be updated or when a given amount ofnew information is available for update. The transmission of the healthcare grant information and the queries can be transmitted over asuitable network medium such as the Internet 50.

The patient data can include any suitable data useful or necessary forapplying for or qualifying for health care grants. For instance, thepatient data can include credit data. Also, the patient data can includeinsurance data. Finally, the patient data can further include incomedata. Typically, when applying for Medicare and Medicaid, an asset testis performed to determine financial aid eligibility. In the presentinvention, a credit report can be used in lieu of such asset test.Still, these examples are not intended to be limiting and are onlyexemplary of possible patient data. In particular, as is known in theart, such patient data information typically is used by health caregrant systems to make decisions as to health care grant qualificationswhich can be utilized.

Qualification criteria can be identified in the health care grantinformation. This identification can be performed by a local dataprocessing system 14 or by a remote data processing system 54. In eithercase, the qualification criteria are compared to the patient data todetermine if the patient data satisfies the criteria. This comparisoncan be performed by a local data processing system 14 or by a remotedata processing system 54. For example, in one aspect of the invention,the qualification criteria can include a debt to income ratio. Inparticular, the debt to income ratio can be computed as an adjustable,programmable, benchmark for automatic approval or denials for financialaid.

The health care grant information that is obtained can include healthcare grant amounts for the health care grant systems. These amounts canthen be compared with the amount of health care costs for the patient,to determine the balance to be paid by the patient. Arrangements canthen be made to obtain financing for all or some portion of the healthcare costs of the patient that are in excess of the grant amount.

Upon determining that the patient data satisfies the qualificationcriteria, a notification is created to identify that a grant can beobtained. This notification can be in the form of letter or e-mailcorrespondence identifying the particular grant, the grant amount, andany necessary application data. In one aspect, the notification includesa printout or electronic form for applying for the grant. The patient 24or health care provider 20, or another third party, can then makeapplication for the grant. Prompt application for the grant isbeneficial as grants can expire, grant amounts can change, and patientdata can change with time.

A flow diagram illustrating the method of the invention is shown in FIG.2. The method begins with step 70, wherein health care grant informationis collected into a single database. Patient data is received in step74. The patient data can be used as part of the financial aidapplication process. Notably, in step 74 a phone number of the patientcan be acquired. Subsequently, an automatic reverse telephone numberlookup can be performed in order to verify residence informationincluded as part of the financial aid process.

Qualification criteria is identified in step 78. In step 82 thequalification criteria is compared to the patient data and it isdetermined if the patient data satisfies the qualification criteria. Ifnot, the method cycles through a path 86 to compare the patient dataqualification criteria from another health care grant system, whereuponthe qualification criteria is again identified in step 78. If thepatient data satisfies the criteria, a notification is created in step90.

The invention also comprises a machine readable storage having storedthereon a computer program for financing health care. The computerprogram has a plurality of code sections executable by a machine forcausing the machine to perform the steps of receiving patient data in adata processing system; collecting from disparate health care grantsystems health care grant information into a single database;identifying qualification criteria in the health care grant information;comparing the patient data to the qualification criteria and, if thepatient data satisfies the criteria, creating a notification that thecriteria have been met.

This invention can be embodied in other forms without departing from thespirit or essential attributes thereof, and accordingly, referenceshould be had to the following claims, rather than the foregoingspecification, as indicating the scope of the invention.

1. A computer program product stored on a computer-readable medium, thecomputer program product having computer-executable code instructionswhich are executable on a computer server to determine eligibility of apatient to receive health care financial assistance, thecomputer-executable code instructions comprising: first codeinstructions for receiving patient data; second code instructions forcomparing at least a portion of the patient data to qualificationcriteria for each of a plurality of health care financial assistanceplans stored in a database within a computer memory, each of theplurality of health care financial assistance plans offering defraymentof at least a portion of a health care expense incurred by the patientif the patient qualifies for the respective health care financialassistance plan; third code instructions for determining if thecomparison satisfies the qualification criteria for at least one of theplurality of health care financial assistance plans; and fourth codeinstructions for providing notification of eligibility for every one ofthe plurality of health care financial assistance plans in which thecomparison satisfied the qualification criteria.
 2. Thecomputer-readable medium of claim 1, further comprising fifth codeinstructions for receiving credit information derived from a creditreport of the patient; and sixth code instructions for comparing atleast a portion of the credit information to the qualification criteriafor each of the plurality of health care financial assistance plansstored in the database.
 3. The computer-readable medium of claim 1,wherein at least one of the health care financial assistance plans isprovided by an entity selected from the group consisting of a hospital,a private foundation, a for-profit entity, and a not-for-profit entity.4. The computer-readable medium of claim 1, wherein at least one of thehealth care financial assistance plans is selected from the groupconsisting of Medicare, Medicaid, WAGES, TANF, and WIC.
 5. Thecomputer-readable medium of claim 1, wherein the qualification criteriaincludes a debt to income ratio.
 6. The computer-readable medium ofclaim 1, further comprising fifth code instructions for verifyingresidence information of the patient.
 7. A computer-based system fordetermining eligibility of a patient to receive health care financialassistance, the system comprising: a computer server; a computer memoryhaving computer-executable code instructions stored therein comprising:first code instructions for receiving patient data; second codeinstructions for comparing at least a portion of the patient data toqualification criteria for each of a plurality of health care financialassistance plans stored in a database within the memory, each of theplurality of health care financial assistance plans offering defraymentof at least a portion of a health care expense incurred by the patientif the patient qualifies for the respective health care financialassistance plan; third code instructions for determining if thecomparison satisfies the qualification criteria for at least one of theplurality of health care financial assistance plans; and fourth codeinstructions for providing notification of eligibility for every one ofthe plurality of health care financial assistance plans in which thecomparison satisfied the qualification criteria.
 8. The system of claim7, wherein the computer-executable code instructions stored within thememory further comprising: fifth code instructions for receiving creditinformation derived from a credit report of the patient; and sixth codeinstructions for comparing at least a portion of the credit informationto the qualification criteria for each of the plurality of health carefinancial assistance plans stored in the database.
 9. The system ofclaim 7, wherein at least one of the health care financial assistanceplans is provided by an entity selected from the group consisting of ahospital, a private foundation, a for-profit entity, and anot-for-profit entity.
 10. The system of claim 7, wherein at least oneof the health care financial assistance plans is selected from the groupconsisting of Medicare, Medicaid, WAGES, TANF, and WIC.
 11. The systemof claim 7, wherein the qualification criteria includes a debt to incomeratio.
 12. The system of claim 7, wherein the computer-executable codeinstructions stored within the memory further comprising fifth codeinstructions for verifying residence information of the patient.
 13. Amethod in a computer system having a computer server processor and acomputer memory for determining eligibility of a patient to receivehealth care financial assistance, the method comprising the steps of:receiving at the computer server processor, over a communication networkfrom a plurality of client machines, health care financial assistanceinformation, including qualification criteria, for each of a pluralityof health care financial assistance plans, each of the plurality ofhealth care financial assistance plans offering defrayment of at least aportion of a health care expense incurred by the patient if the patientqualifies for the respective health care financial assistance plan;storing the health care financial assistance information in a databasewithin the memory; receiving at the computer server processor, over acommunication network from a client machine, patient data; comparingusing the computer server processor at least a portion of the patientdata to qualification criteria for each of a plurality of health carefinancial assistance plans stored in the database within the memory;determining using the computer server processor if the comparisonsatisfies the qualification criteria for at least one of the pluralityof health care financial assistance plans; and transmitting from thecomputer server processor notification of eligibility for every one ofthe plurality of health care financial assistance plans in which thecomparison satisfied the qualification criteria.
 14. The method of claim13, further comprising the steps of: receiving at the computer serverprocessor, over a communication network from a client machine, creditinformation derived from a credit report of the patient; and comparingusing the computer server processor at least a portion of the creditinformation to the qualification criteria for each of the plurality ofhealth care financial assistance plans stored in the database.
 15. Themethod of claim 13, wherein the health care financial assistanceinformation includes health care grant amounts for the health carefinancial assistance plan.
 16. The method of claim 13, wherein at leastone of the health care financial assistance plans is provided by anentity selected from the group consisting of a hospital, a privatefoundation, a for-profit entity, and a not-for-profit entity.
 17. Themethod of claim 13, wherein at least one of the health care financialassistance plans is selected from the group consisting of Medicare,Medicaid, WAGES, TANF, and WIC.
 18. The method of claim 13, wherein thequalification criteria includes a debt to income ratio.
 19. The methodof claim 13, further comprising the step of verifying using the computerserver processor residence information of the patient.
 20. The method ofclaim 19, wherein the step of verifying residence information of thepatient is facilitated by a reverse telephone number lookup.